Endoscopic treatment and risk factors of postoperative anastomotic bleeding after gastrectomy for gastric cancer

Int J Surg. 2012;10(10):593-7. doi: 10.1016/j.ijsu.2012.09.026. Epub 2012 Sep 26.

Abstract

Background: Anastomotic leakage, bleeding, and stricture are major complications after gastrectomy. Of these complications, postoperative anastomotic bleeding is relatively rare, but lethal if not treated immediately.

Methods: Of 2031 patients with gastric cancer who underwent radical gastrectomy (R0 resection) between January 2002 and December 2010, postoperative anastomotic bleeding was observed in 7 patients. The clinicopathological features, postoperative outcomes such as surgical procedures, bleeding sites and, methods used to achieve hemostasis, and the risk factors of anastomotic bleeding of these 7 patients were analyzed.

Results: Of the 2031 patients, 1613 and 418 underwent distal and total gastrectomy, respectively. The bleeding sites were as follows: Billroth-I anastomosis using a circular stapler (n = 1), Billroth-II anastomosis by manual suture (n = 5), and esophagojejunostomy using a circular stapler (n = 1). All patients were treated with endoscopic clipping or epinephrine injection. There was no further endoscopic intervention or reoperation for anastomotic bleeding.

Conclusions: Postoperative anastomotic bleeding is an infrequent but potentially life-threatening complication. Scrupulous surgical procedures are essential for the prevention of postoperative bleeding, and endoscopy was useful for both the confirmation of bleeding and therapeutic intervention.

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Anastomotic Leak / etiology*
  • Anastomotic Leak / surgery
  • Endoscopy, Gastrointestinal / adverse effects*
  • Endoscopy, Gastrointestinal / methods
  • Endoscopy, Gastrointestinal / statistics & numerical data
  • Female
  • Gastrectomy / adverse effects*
  • Gastrectomy / methods
  • Gastrectomy / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology*
  • Postoperative Hemorrhage / surgery
  • Retrospective Studies
  • Risk Factors
  • Stomach Neoplasms / surgery*
  • Treatment Outcome